Caregiving for a close family member with Alzheimer’s disease is a stressful situation to be in, that often leads to high levels of caregiver burden and subsequent stress and depressive symptoms, and while there are numerous community and government resources available to caregivers, there are aspects of Hispanic cultures that may lead Hispanic caregivers to have higher levels of caregiver burden and depressive symptoms than White caregivers. 80 Hispanic caregivers and 80 White caregivers, with 40 males and 40 females within each group, will be recruited to participate in this study. Scales will be administered to both Hispanic and White caregivers in order to assess levels of caregiver burden, depressive symptoms, familism values, gender role beliefs, acculturation levels, and knowledge, comfort, and use of community resources. Hispanic caregivers will have higher levels of caregiver burden and depressive symptom scores than White caregivers, while women will have higher scores overall than men overall. Hispanic caregivers will have less knowledge, comfort, and use of community resources than White caregivers, while gender role views, familism values, and acculturation levels will be mediating factors of these relationships. Cultural differences in caregiver burden need to be assessed further, so that clinical and practical implications for community and government resources can be discussed.

The burden of Streptococcus suis infection in humans is increasing worldwide. In Thailand, S. suis is the second most commonly recorded zoonosis. The principal sources of human S. suis infection are pig and pork products. A detailed understanding of the epidemiological characteristics of S. suis and the burden of the disease may help improve prevention and control policy to reduce the burden of this bacterial infection. The work presented in this thesis focuses on human outbreaks of S. suis in Chiang Mai, Thailand, in humans and backyard pigs. This thesis examined the characteristics of previous outbreaks of S. suis in humans and calculated the incidence, disease burden and the associated economic burden of S. suis infection in Chiang Mai. The backyard pig system is important for S. suis transmission and this thesis examined the characteristics of the backyard pig production system in Chaing Mai and examined the prevalence and risk factor for S. suis infection in pigs. Finally, to examine transmission of S. suis, isolates collected during this study were identified and subject to molecular characterization. A retrospective analysis of surveillance data for S. suis cases in Chiang Mai between 2005 to 2014 highlighted the annual incidence rate over this ten year period of 15.52 per 1,000,000 population, 6.5 times higher than for the rest of Thailand (2.37 per 1,000,000 population). The case fatality rate was high at 10.12%. The impact on human health of S. suis infection was derived from surveillance data for the year 2013. The health burden measured in term of Disability Adjusted Life Years (DALYs) was estimated at 7.41 per 100,000 population. Most of the health burden (98.28%) was in adults aged 15-64 years. Males had 3.5 times the health burden of females. The consequences of hearing loss and deafness had significant impacts on affected individuals quality of life. The economic impact of S. suis outbreaks in Chiang Mai was between 2013 and 2014 was estimated from interview data. Most patients were covered for their health costs by the national health security scheme, with expenditure due to S. suis on average being 37,955 baht (£759) per patient. Out of pocket expenses for individuals and their families averaged 5,198 baht (£104) per patient. An epidemiological survey of backyard pig production facilities was undertaken in Chiang Mai province where there was a reported high incidence of S. suis cases in humans occurred each year. Most holdings had between one to five pigs and all holdings shared similar characteristics and management practices. The prevalence of S. suis was in pigs was 4.8% (95%CI=2.2-7.4%). Pigs living in larger spaces (≥ 1.2 m2) showed a lower risk for S. suis infection (OR = 4.35, 95% CI = 1.07-25.21). Examination of the isolates from this study revealed a diversity of serotypes. Only one isolate was identified as S. suis serotype 9. The rest did not match any common serotypes for S. suis (1, 2, 7 or 9) and known virulent strains were not identified. Twelve independent sequence profiles were determined by MLST, of which, 11 were novel. Backyard pigs were found to be commonly infected with a range of previously unidentified S. suis and may be a significant reservoir of human infection.

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa.

Esta dissertação tem como objetivo principal analisar o cabimento, no direito processual brasileiro, de uma distribuição dinâmica das regras do ônus da prova. Na primeira parte, são analisados o conceito, o objeto e a finalidade da prova, com apontamento da distinção entre fontes e meios. Após, são estudados o conceito de ônus da prova e sua distinção da obrigação, dando ênfase aos seus aspectos objetivo e subjetivo e às principais teorias, antigas e modernas, que tratam dos critérios para a distribuição do ônus da prova. Estudou-se, em seguida, os principais fenômenos relacionados ao ônus da prova, quais sejam a distribuição, cuja regra geral está no art. 333 do CPC, e a redistribuição como gênero, tendo com espécies a redistribuição strictu sensu, cabível em casos de probatio diabolica e em excepcionais casos em que a prova se apresenta difícil por fatores externos ao processo, e a inversão, cujo exemplo, no direito pátrio, é o art. 6o, inc. VIII, do CDC. Na segunda parte do trabalho, são apresentadas duas novas teorias sobre a distribuição do ônus da prova: a visão solidarista do ônus da prova e a teoria dinâmica dos ônus probatórios. Por fim, ante a necessidade de flexibilização das atuais regras gerais de distribuição do ônus da prova e, ao mesmo tempo, controle do excessivo subjetivismo judicial, analisa-se o cabimento da aplicação da teoria dinâmica no direito brasileiro, apontando-se os parâmetros para a decisão judicial que a aplique. Do estudo, concluiu-se que o direito processual brasileiro admite a aplicação da teoria dinâmica dos ônus probatórios em face da incidência do princípio da igualdade, dos poderes instrutórios do juiz e do dever de lealdade, boa-fé e colaboração das partes. Concluiuse, ainda, que embora possa acontecer em momento diverso, o momento mais oportuno para a ocorrência da redistribuição do ônus da prova é a audiência preliminar, não podendo se verificar, em nenhuma hipótese, surpresa às partes, sob pena de ferimento ao princípio do contraditório. Quanto à decisão judicial que aplica a teoria dinâmica, deve esta levar em conta que tal aplicação é de caráter excepcionalíssimo, devendo ser bem fundamentada. / This study has the purpose of analyzing a dynamic employment of the burden of proof in the Brazilian Procedural Law. In the first part of this study, the concept and object and the evidence are analyzed through distinguishing sources and ways. Afterwards, the concept of burden of proof and its difference from obligation are studied based on subjective and objective aspects of dominant old and modern theories. We also examined the main phenomena relating to the burden of proof in general presented on the art. 333 Brazilian Procedural Code, the presentation of the burden of proof strict sensu in case of probatio diabolica and the shifting of burden of proof based on the art. 6, inc.VII, Brazilian Consumption Code. In the second part of the study, two theories related to the shifting of the burden of proof are presented. Based on those two theories, we came to the conclusion that a more dynamic way of applying the general rules for shifting the burden of proof and excessive control of judicial subjectivism is necessary to reach fairness. Finally, we concluded that the Brazilian Procedural Law allows the application of the dynamic theory of burden of proof based on the principle of equity, discretion, loyalty, good faith and the collaboration of the parties. Besides, the best moment to submit some evidence for the shifting of the burden of proof is over the course of a hearing. The decision shall be based on legal matters, facts and principles due to the fact that the dynamic theory to analyze evidence in case of shifting the burden of proof is used in special cases.

Esta dissertação tem como objetivo principal analisar o cabimento, no direito processual brasileiro, de uma distribuição dinâmica das regras do ônus da prova. Na primeira parte, são analisados o conceito, o objeto e a finalidade da prova, com apontamento da distinção entre fontes e meios. Após, são estudados o conceito de ônus da prova e sua distinção da obrigação, dando ênfase aos seus aspectos objetivo e subjetivo e às principais teorias, antigas e modernas, que tratam dos critérios para a distribuição do ônus da prova. Estudou-se, em seguida, os principais fenômenos relacionados ao ônus da prova, quais sejam a distribuição, cuja regra geral está no art. 333 do CPC, e a redistribuição como gênero, tendo com espécies a redistribuição strictu sensu, cabível em casos de probatio diabolica e em excepcionais casos em que a prova se apresenta difícil por fatores externos ao processo, e a inversão, cujo exemplo, no direito pátrio, é o art. 6o, inc. VIII, do CDC. Na segunda parte do trabalho, são apresentadas duas novas teorias sobre a distribuição do ônus da prova: a visão solidarista do ônus da prova e a teoria dinâmica dos ônus probatórios. Por fim, ante a necessidade de flexibilização das atuais regras gerais de distribuição do ônus da prova e, ao mesmo tempo, controle do excessivo subjetivismo judicial, analisa-se o cabimento da aplicação da teoria dinâmica no direito brasileiro, apontando-se os parâmetros para a decisão judicial que a aplique. Do estudo, concluiu-se que o direito processual brasileiro admite a aplicação da teoria dinâmica dos ônus probatórios em face da incidência do princípio da igualdade, dos poderes instrutórios do juiz e do dever de lealdade, boa-fé e colaboração das partes. Concluiuse, ainda, que embora possa acontecer em momento diverso, o momento mais oportuno para a ocorrência da redistribuição do ônus da prova é a audiência preliminar, não podendo se verificar, em nenhuma hipótese, surpresa às partes, sob pena de ferimento ao princípio do contraditório. Quanto à decisão judicial que aplica a teoria dinâmica, deve esta levar em conta que tal aplicação é de caráter excepcionalíssimo, devendo ser bem fundamentada. / This study has the purpose of analyzing a dynamic employment of the burden of proof in the Brazilian Procedural Law. In the first part of this study, the concept and object and the evidence are analyzed through distinguishing sources and ways. Afterwards, the concept of burden of proof and its difference from obligation are studied based on subjective and objective aspects of dominant old and modern theories. We also examined the main phenomena relating to the burden of proof in general presented on the art. 333 Brazilian Procedural Code, the presentation of the burden of proof strict sensu in case of probatio diabolica and the shifting of burden of proof based on the art. 6, inc.VII, Brazilian Consumption Code. In the second part of the study, two theories related to the shifting of the burden of proof are presented. Based on those two theories, we came to the conclusion that a more dynamic way of applying the general rules for shifting the burden of proof and excessive control of judicial subjectivism is necessary to reach fairness. Finally, we concluded that the Brazilian Procedural Law allows the application of the dynamic theory of burden of proof based on the principle of equity, discretion, loyalty, good faith and the collaboration of the parties. Besides, the best moment to submit some evidence for the shifting of the burden of proof is over the course of a hearing. The decision shall be based on legal matters, facts and principles due to the fact that the dynamic theory to analyze evidence in case of shifting the burden of proof is used in special cases.

Human biomonitoring is a term for colleting and evaluating data concerning the pollution of environment and its influence on human body. In the CR it is being conducted since 1994 and its main aim is to protect people's health. The most commonly observed pollutants are heavy metals, PCBs, dioxins, chlorinated pesticides and many others. These pollutants find their way to the environment mainly due to people's industrial and agricultural activities. Smoking is still a current issue that needs to be addressed and it is an activity (voluntarily or in case of passive smoking involuntarily practiced) that causes health damage. Due to human biomonitoring, or more precisely due to principles which are now its foundation, many shortcomings of former industrial activities were discovered. Among others, it leads to understanding "Itai-itai" disease and discovering the cause of events in Japanese bay "Minamata". Today, the industrial (but also other) activities worldwide are at a high level of development. Many chemicals are being used and the environment is still being threatened. Based on those facts it is necessary to continually monitor the presence of toxic (or potentially toxic) substances in the environment and to put forth an extra effort to prevent exposure to these substances. Human biomonitoring is also...

My thesis is focused on the legal regulations of property taxes in the Czech Republic and its comparison with the chosen state of the European Union (Germany). The theoretical part describes a taxation system of road tax, real estate tax and inheritance tax, gift tax and real estate-transfer tax. And also a taxation system of road tax and real estate tax in Germany, because during the year 2007 it happened neither to a gift, succession nor a real estate transfer. The practical part is about the company Groz-Beckert, s.r.o. which has a subsidiary company in the Czech Republic and a controlling company in Albstadt in Germany. Then the comparison is made so these vehicles, land and buildings owned by the company in the Czech Republic would be also owned in the same quantity in Germany. It solves how much more the company had to pay in taxes and if the Czech Republic is for this company much more advantageous from the point of view of property taxes.

O adoecimento de um membro familiar costuma acarretar inúmeras alterações em toda a estrutura e dinâmica familiar. Com a progressão e o agravamento da doença, quando a pessoa se encontra sem possibilidade de tratamento modificador da doença, aumenta o sofrimento tanto da pessoa adoecida quanto de sua família. O cuidador familiar de pessoas idosas em cuidados paliativos sofre junto ao enfermo, podendo enfrentar sobrecarga física, emocional e social decorrente da tarefa de cuidar e da possibilidade da morte. Entretanto, são escassos os estudos que avaliam a sobrecarga desta população. O objetivo deste estudo é identificar e analisar a percepção de sobrecarga por parte do cuidador familiar de idosos em cuidados paliativos. Trata-se de uma pesquisa do tipo transversal, exploratório, de metodologia quantitativa, não probabilística, com uma casuística total composta por 100 pessoas. Essa casuística foi estratificada de acordo com escore obtido por meio da aplicação do protocolo Karnofsky Performance Scale (KPS) com os idosos (com 60 anos ou acima) em cuidados paliativos oncológicos: um grupo com 25 cuidadores familiares de idosos com KPS abaixo de 40%; um grupo com 25 cuidadores de idosos em cuidados paliativos oncológicos com KPS de 70%, 60% ou 50%; um grupo controle com 50 cuidadores familiares de idosos em cuidados paliativos oncológicos, com KPS maior ou igual a 80%. Durante a coleta de dados, além do KPS, foram aplicados o questionário de caracterização clínica e sociodemográfica e os protocolos: Questionário de Classificação Socioeconômica Brasil e o Caregiver Burden Scale (CBScale), validado no Brasil. Para análise dos dados, foi realizada estatística descritiva e as comparações com os grupos foram feitas por meio do Teste Exato de Fisher e de um modelo de regressão quantílica. As análises foram feitas pelo software SAS 9.0 e Stata versão 13. Os resultados indicaram que os cuidadores familiares são, em sua maioria, mulheres, filhas ou esposas, de meia idade a idade mais avançada, predominantemente, na faixa etária de 56 a 71 anos, com baixa escolaridade, pertencentes a classes sociais C e que não realizam nenhuma atividade remunerada. Os maiores índices de sobrecarga foram percebidos em cuidadores do sexo feminino e em cuidadores de idosos os quais apresentam menores escores relativos à capacidade funcional (avaliados pelo KPS). Conclui-se que o agravamento da doença, o declínio funcional do idoso e a possibilidade da sua morte mais próxima fazem aumentar a sobrecarga dos cuidadores, com impactos na sua saúde e qualidade de vida, o que indica a necessidade de oferecimento de serviços de apoio a essa população o mais precocemente possível / The illness of a family member often brings on numerous changes throughout the structure and family dynamics. With the progression and worsening of the disease, when the person has no possibility of modifying the disease treatment, the suffering of the ill person and the family increases. The family caregivers of the elderly in palliative care suffer with the ill person and may face physical, emotional and social burden from the task of caring for and the possibility of death. However, there are only few studies assessing the burden of this population. The aim of this study is to identify and analyze the perception of burden on the part of caregivers of seniors in palliative care. It is a cross-sectional survey, exploratory, quantitative methodology, non-probabilistic, with the full sample composed of 100 people. This sample was stratified according to the score obtained by applying the Karnofsky Performance Scale (KPS) to the elderly (aged 60 and above) in oncology palliative care: a group of 25 family caregivers of elderly patients with KPS below 40%; a group of 25 caregivers of elderly in oncology palliative care with KPS of 70%, 60% or 50%; a control group of 50 family caregivers of elderly in oncology palliative care, with KPS greater than or equal to 80%. During data collection, in addition to KPS, it was applied a questionnaire clinical and sociodemographic and protocols: Brazil Economic Classification Criteria and the Caregiver Burden Scale (CBScale), validated in Brazil. For data analysis, it was performed descriptive statistics and comparisons with groups; they were made by Fisher\'s exact test and a Regression Quantiles Model. The analyses were performed using the software SAS 9.0 and Stata version 13. The results indicated that family caregivers are mostly women, daughters or wives, from middle- aged to older ages predominantly in the age group of 56-71, poorly educated, and belonging to social classes C and they do not perform any remunerated activity. The largest burden rates were seen in female caregivers and caregivers of seniors who have lower scores related to functional capacity (assessed by KPS). In conclusion, the aggravation of the disease, the functional decline of the elderly and the possibility of death increase the burden on caregivers, with impacts on their health and quality of life, which indicates the need of offering support services to this population as soon as possible

O envelhecimento populacional é um dos maiores triunfos da humanidade, porém um dos grandes desafios para os gestores de saúde. Associado ao processo do envelhecimento, o declínio da capacidade física e cognitiva pode ocorrer, levando o idoso à perda progressiva da autonomia e independência. Assim, a família é quem, geralmente, assume a responsabilidade do cuidado de forma despreparada, contribuindo para quadros depressivos, de ansiedade e de sobrecarga no cuidador. A falta de conhecimento sobre o idoso, na comunidade de Ribeirão Preto, bem como da sobrecarga da atividade de prestar cuidado no domicílio perfazem a relevância deste estudo. Os objetivos foram identificar e caracterizar idosos na comunidade de Ribeirão Preto, avaliar a função cognitiva e a independência funcional dos idosos e a sua relação com sexo, idade, estado civil e escolaridade e caracterizar os cuidadores familiares bem como descrever a sobrecarga e o desconforto emocional dos mesmos em relação à atividade do cuidar. Este representa um estudo epidemiológico, descritivo e transversal com idosos de 65 anos ou mais de idade e seus respectivos cuidadores, ambos os sexos, residentes na área urbana de Ribeirão Preto, São Paulo. Foram utilizados os seguintes instrumentos: Caracterização do idoso; Miniexame do Estado Mental (MEEM); Medida da Independência Funcional (MIF); Instrumento para Caracterização do Cuidador; Escala de Sobrecarga de Zarit; Self Reporting Questionnaire (SRQ-20). Do total de 574 idosos, que se caracterizaram pela média de 76,6 anos de idade, 67,8% do sexo feminino, 54,7% com baixa escolaridade, 19,7% com deficit cognitivo e 15,7% com algum grau de dependência funcional, 21,6% possuíam cuidadores. Dentre os 124 cuidadores estudados, 85,6% eram do sexo feminino, com média de 56,5 anos de idade, 37,9% com baixa escolaridade, 90,3% eram familiares (filhas e esposas principalmente), 79,8% residiam com o idoso, utilizando, em média, 12,4 horas diárias para o cuidar. Os resultados evidenciaram que os cuidadores apresentam leve a moderada sobrecarga. Após a regressão linear múltipla, a dependência funcional do idoso e as características dos cuidadores como sexo feminino e tempo em horas semanais para o cuidado diário foram os preditores da sobrecarga (p<0,05). Encontrou-se, também, que a sobrecarga é fator de risco para desconforto emocional (p<0,05). Sugerem-se outros estudos na área e intervenções com os cuidadores que residem na comunidade, utilizando instrumentos de avaliação, validados para a população brasileira. As pesquisas realizadas nessa área enfocam, na maioria das vezes, o cuidador de idoso com demência, o que trará não só resultados para os cuidadores como também para os pacientes, pois sem sobrecarga e desconfortos o cuidador estará renovado para cuidar. / Population aging represents one of the major advancements of humanity but it is also a great challenge to health managers. Decreased physical and cognitive abilities are associated to the aging process and lead to elderly individuals\' progressive loss of autonomy and independence. As a consequence, family members assume the responsibility to provide care with no previous preparedness, which leads caregivers to develop depressive conditions such as anxiety and burden. The lack of knowledge concerning elderly individuals in the community of Ribeirão Preto, SP, Brazil and burden that results from delivering care at home are the topic of this study. It identifies and characterizes elderly individuals in the community of Ribeirão Preto, evaluates their cognitive function and functional independence and relates these variables with gender, age, marital status, and schooling. Family caregivers are also characterized, while burden and emotional discomfort is evaluated in relation to the care activity. This epidemiological, descriptive and transversal study was carried out with 65 years old or older individuals and their respective caregivers, both genders, residents in the urban area of Ribeirão Preto, SP, Brazil. The following instruments were used: instrument to characterize the elderly individuals; Mini-mental State Examination (MMSE); Functional Independence Measure (FIM); instrument to characterize caregivers; Zarit Burden Scale; Self-Reporting Questionnaire (SRQ-20). The total of 574 elderly individuals were 76.6 years old in average, 67.8% were female, 54.7% had low levels of schooling, 19.7% had low cognitive performance and 15.7% some degree of functional dependence, while only 21.6% had caregivers. Among the 124 caregivers, 85.6% were female and 56.5 years old in average, 37.9% had low levels of schooling, 90.3% were family members (mainly daughters and wives), 79.8% lived with the elderly individual and spent in average 12.4 hours daily. The results evidenced that the caregivers present low to moderate burden. Multiple linear regression revealed that functional dependence of elderly individuals and caregivers\' characteristics such as being females and time of weekly hours spent in daily care were predictors of burden (p<0.05). Burden is also a risk factor for psychiatric morbidity (p<0.05). We suggest further studies in the field and investigations with caregivers in the community using evaluation instruments validated for the Brazilian population since research in the field usually focuses on caregivers of elderly individuals with dementia. These actions are expected to help caregivers and patients, since with no burden and discomfort, caregivers will be renovated to provide care.

Esta pesquisa tem como objetivo principal desenvolver um modelo capaz de captar como mudanças nas alíquotas dos tributos afetam as diferentes classes de renda e quais são seus impactos na arrecadação do governo. A justificativa para desenvolver o estudo é que as autoridades públicas, no Brasil, não dispõem de mecanismos que permitam fazer tal análise e, provavelmente, esse é um dos motivos pelos quais não foi dada a devida atenção à forma como os impostos indiretos recaem sobre a população. O modelo desenvolvido no presente estudo requer três informações fundamentais: a carga tributária por faixa de renda, a estimação da matriz de elasticidades Marshallianas e o padrão de consumo da população. As simulações são feitas com base nos microdados da POF de 2002-2003. Sendo assim, para alcançar os objetivos propostos pela tese, é feito um estudo detalhado da atual incidência do sistema tributário brasileiro, que vai da averiguação da carga tributária direta, indireta e total por faixa de renda até a estimação de um modelo de sacrifício eqüitativo. Buscou-se detalhar ao máximo as alíquotas dos impostos indiretos, tomando como base as normas tributárias da Federação, das Unidades da Federação e respectivas capitais. Cruzando essas informações com os microdados da POF de 2002-2003, foi possível verificar que o sistema tributário brasileiro é regressivo quando tomada como base a renda. Isso se deve em grande parte aos impostos indiretos, mais especificamente ao ICMS, ao PIS e à COFINS. Contudo, é importante ressaltar que a baixa participação dos impostos diretos não permite equilibrar a carga por faixa de renda. O IR tem uma taxa efetiva bem abaixo da alíquota que está prevista em lei e o IPTU chega a ser regressivo quando analisada a renda familiar total. O estudo também revelou que há diferenças regionais no comportamento dos impostos indiretos. No caso específico dos alimentos, que é um grupo de despesa relevante para as famílias de baixa renda, as maiores cargas foram verificadas nas regiões Norte e Nordeste. Na estimação da matriz de elasticidades Marshallianas a partir dos microdados da POF de 2002-2003 é usada a versão não-linear do sistema quase ideal de demanda (NL-AIDS) para 27 grupos de produtos. Como não é possível obter todos os preços necessários para os produtos nãoalimentícios na POF, foi necessário buscar informações de preços em outras fontes. Para estimar uma função de tributação pressupondo obediência ao princípio de sacrifício eqüitativo, é utilizada a forma proposta por Hoffmann, Silveira e Pintos-Payeras (2006). Os resultados sugerem que o coeficiente de aversão à desigualdade está aumentando no Brasil e isto pode ser interpretado como o desejo da sociedade por uma tributação mais justa. As simulações feitas mostram que o modelo desenvolvido no último capítulo apresenta um razoável desempenho para avaliar os efeitos das mudanças no sistema tributário. Certamente é um recurso adicional que pode ser usado pelas autoridades públicas antes de fazer alterações nas alíquotas tributárias. O modelo permitiu observar que quando é buscada maior progressividade do sistema tributário, é necessário combinar alterações nos impostos diretos e indiretos. / The main objective of this research is to develop a model that is able to evaluate how the effects of changes in tax rates are distributed among the different income classes as well as their impact in the government revenues. This study is relevant, because Brazilian public authorities do not have mechanisms for such analysis, and this is possibly one the reasons why the way indirect taxes affect the population has not been carefully considered so far. The model developed in this study requires three fundamental types of information: the tax burden per income class, the estimate of Marshalls elasticities matrix, and the populations pattern of consumption. Simulations are based on Household Budgeting Survey (POF-2002-2003) microdata. Thus, to reach the objectives proposed by this thesis, a detailed study of the current incidence of the Brazilian tax system was carried out, including the evaluation of direct, indirect and per-class tax burden and the estimation of a tax function assuming equitable sacrifice. Indirect tax rates were detailed as much as possible, considering the tax regulations of the country, states and their respective capital cities. Combining this information with the 2002-2003 POF database, it could be verified that the Brazilian tax system is regressive when based on income. This is mainly due to indirect taxes, and more specifically to Value added tax (ICMS), Social Security (PIS), and Social Security Financing Tax (COFINS). However, we must point out that the low participation of indirect taxes does not allow a balance of the tax burden per income class. Income tax has an effective rate well below the rate established by the law, and municipal tax on properties (IPTU) is regressive, when the total family income is analyzed. The study also showed that there are regional differences as to indirect taxes. Particularly in the case of food, which is a relevant expense group for low income families, higher tax burdens were found for the North and Northeast regions. Marshalls elasticities matrix was estimated using a non-linear version of the almost ideal demand system (NL-AIDS), considering 27 product groups out of the 2002-2003 POF database. As not all the necessary prices for non-food products could be obtained from the POF database, other information sources were used. Tax functions assuming equitable sacrifice were estimated using the procedure proposed by Hoffmann, Silveira and Pintos-Payeras (2006). The results suggest that the coefficient of aversion to inequality is increasing in Brazil and this can be interpreted as the populations desire for a fairer tax system. The simulations show that the model developed in the last chapter has a reasonable performance in the evaluation of the effect of changes in the tax system. It is certainly an additional instrument which can be used by public authorities before establishing changes in the tax rates. The model allowed us to observe that when a higher progressivity of the tax system is attempted, it is necessary to combine changes in direct and indirect taxes.